Initial Serum Ammonia as a Predictor of Neurologic Complications in Patients with Acute Glufosinate Poisoning

Lee, Dong Hoon; Youk, Hyun; Kim, Hyun; Kim, Oh Hyun; Go, Jin; Kim, Tae Hoon; Cha, Kyoung‐Chul; Lee, Kang Hyun; Hwang, Sung Oh; Sung, Yong

doi:10.3349/ymj.2016.57.1.254

Cited by 16 publications

(22 citation statements)

References 13 publications

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“…3 Although glufosinate ammonium herbicides are considered safe when used properly, 4 many clinical toxicologists have reported that the ingestion of a large amount of glufosinate ammonium can cause convulsions. 5 –8…”

Section: Introductionmentioning

confidence: 99%

Seizures in patients with acute pesticide intoxication, with a focus on glufosinate ammonium

et al. 2017

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The incidence and clinical aspects of seizures remain to be elucidated in patients with acute pesticide intoxication. The present study included subjects who ingested pesticide with the intention of committing suicide and were treated at Soonchunhyang University Hospital (Cheonan, Korea) between January 2011 and December 2014. We analyzed the incidence and characterized the type and frequency of seizure, from the medical records of 464 patients with acute pesticide intoxication, according to the pesticide class. The effect of seizure on the clinical outcome was assessed. The incidence of seizure was 31.5% in patients who ingested glufosinate ammonium {2-amino-4-[hydroxyl (methyl) phosphinoyl] butyrate; ammonium DL-homoalanin-4-yl (methyl) phosphinate}, followed by those who ingested pyrethroid (5.9%) or glycine derivatives (5.4%). All of the seizures developed between 12 and 24 h of pesticide ingestion and had ceased by 72 h after seizure initiation, following treatment with antiseizure medication. Generalized tonic-clonic seizures were the most commonly observed (85.7% of the cases). Multivariable logistic regression analysis showed that the effect of seizure on mortality was not statistically significant. In conclusion, glufosinate ammonium herbicide is the most common seizurogenic pesticide class. Seizure itself was not a risk factor for mortality in patients with acute glufosinate ammonium intoxication.

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Section: Introductionmentioning

confidence: 99%

Seizures in patients with acute pesticide intoxication, with a focus on glufosinate ammonium

et al. 2017

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“…In this study, 72.0% of the patients were placed in the neurologic complication group. Some differences in the incidence of neurologic complications in previous studies exist 3,5,12,13 that may have occurred due to the definition of complication group and the severity of poisoned patients. However, similarities in the results of recent human studies (including our prospective study) indicate that acute glufosinate ammonium poisoning causes serious complications much more often than previously reported.…”

Section: Discussionmentioning

confidence: 89%

“…All patients with hyperammonemia upon ED arrival received a lactulose enema to lower the ammonia level, as high levels have been suggested to cause neurologic complications. 12 All glufosinate ammonium–poisoned patients were admitted to the intensive care unit (ICU) for close observation for more than 1 day.…”

Section: Methodsmentioning

confidence: 99%

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The relationship between serum ammonia level and neurologic complications in patients with acute glufosinate ammonium poisoning: A prospective observational study

Kim

Lee

et al. 2017

Hum Exp Toxicol

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Glufosinate ammonium poisoning can cause neurological complications even after a symptom-free period. We prospectively investigated the predictors of neurologic complications in acute glufosinate ammonium poisoning and the change of serum ammonia level as a predictor of patient's presence and recovery of neurologic complication. This prospective observational study collected data from consecutive patients diagnosed with acute glufosinate ammonium poisoning between September 2014 and June 2016. Serum ammonia was serially measured. The patients were divided into two groups: the neurologic complication group and the nonneurologic complication group. We also defined 25 other insecticide- or herbicide-poisoned patients as controls. The neurologic complication group included 18 patients (72.0%). The latency period for neurologic complications was within 48-h postingestion. The peak ammonia level was statistically higher in the neurologic complication group than in the control group ( p < 0.001) and the nonneurologic complication groups ( p = 0.001). There was a statistical difference between the nonneurologic complication group and the neurologic complication group ( p = 0.0085) in terms of ingested amount. The peak ammonia was the only predictor for the development of neurologic complications (the optimal cutoff: 90 μg/dL). In patients with mental changes, the mean serum ammonia levels before and after recovery of the mental changes were statistically different ( p = 0.0019). In acute glufosinate ammonium poisoning, serial serum ammonia level measurements are needed and a serum peak ammonia level greater than 90 μg/dL is a predictor of neurologic complications. Also, it is important to treat the hyperammonemia in acute glufosinate ammonium poisoning.

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“…The seven studies that were not suitable for prevalence‐of‐intubation pooling had cohorts that consisted entirely of those that were intubated, making a calculation of prevalence impossible . A comprehensive listing of the 46 articles with a description of study characteristics, prevalence‐bias assessment, and intubation prevalence are shown in Table S1 …”

Section: Resultsmentioning

confidence: 99%

Review article: Emergency endotracheal intubation in non‐traumatic brain pathologies: A systematic review and meta‐analysis

Fouche

Stein

Jennings

et al. 2019

Emerg Medicine Australasia

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Endotracheal intubation is an advanced airway procedure performed in the ED and the out-ofhospital setting for acquired brain injuries that include non-traumatic brain pathologies such as stroke, encephalopathies, seizures and toxidromes. Controlled trial evidence supports intubation in traumatic brain injuries, but it is not clear that this evidence can be applied to nontraumatic brain pathologies. We sought to analyse the impact of emergency intubation on survival in non-traumatic brain pathologies and also to quantify the prevalence of intubation in these pathologies. We conducted a systematic literature search of Medline, Embase and the Cochrane Library. Eligibility, data extraction and assessment of risk of bias were assessed independently by two reviewers. A bias-adjusted metaanalysis using a quality-effects model pooled prevalence of intubation in non-traumatic brain pathologies. Forty-six studies were included in this systematic review. No studies were suitable for meta-analysis the primary outcome of survival. Thirtynine studies reported the prevalence of intubation in non-traumatic brain pathologies and a meta-analysis showed that emergency intubation was used in 12% (95% CI 0-33) of pathologies. Endotracheal intubation was used commonly in haemorrhagic stroke 79% (95% CI 47-100) and to a lesser extent for seizures 18% (95% CI 10-27) and toxidromes 25% (95% CI 6-48). This systematic review shows that there is no high-quality clinical evidence to support or refute emergency intubation in non-traumatic brain pathologies. Our analysis shows that intubation is commonly used in non-traumatic brain pathologies, and the need for rigorous evidence is apparent.

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Initial Serum Ammonia as a Predictor of Neurologic Complications in Patients with Acute Glufosinate Poisoning

Cited by 16 publications

References 13 publications

Seizures in patients with acute pesticide intoxication, with a focus on glufosinate ammonium

Seizures in patients with acute pesticide intoxication, with a focus on glufosinate ammonium

The relationship between serum ammonia level and neurologic complications in patients with acute glufosinate ammonium poisoning: A prospective observational study

Review article: Emergency endotracheal intubation in non‐traumatic brain pathologies: A systematic review and meta‐analysis

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